Contact Allergy in Patients With Chronic Venous Leg Ulcers

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• In this study, 97 patients with chronic leg ulcers (CLUs) due to venous stasis present for more than 6 weeks (mean duration of ulcer, 3.8 years) were patch tested using the Leg Ulcer Series (LUS), which contains 27 chemicals and 5 additional substances pertinent for wound treatment. Of these, 52 patients underwent additional patch testing with the European Baseline Series (EBS). Patch testing was positive for 31 of 97 patients (32%) for the LUS and 5 additional substances with wood tar mix, benzalkonium chloride, fusidic acid, INTRASITE Gel, budesonide, and hydrocortisone-17-butyrate being the most frequent allergens. Of the 52 patients, 27 (52%) tested to the EBS had positive patch test readings with Myroxylon pereirae, fragrance mix, and colophonium being the most frequent allergens in this series.

• Although this study is limited as readings were only performed on day 3, the authors noted a high prevalence of contact allergy in chronic venous leg ulcer patients. They also identified multiple relevant allergens that are commonly used in this patient population and recommend patch testing with the LUS and EBS to avoid using treatments that could hinder wound healing.

– Alex Noble, MD

Written by

 

 

Christen Maria Mowad MD

Chronic leg ulcers are a common clinical problem in the dermatologist's office. Leg ulcerations can be due to numerous underlying etiologies but can also be complicated by contact allergy, which can delay wound healing. Allergic contact dermatitis can be increased in this setting due to the impaired epidermal barrier and the multitude of products and dressings applied to the wounds.

This study from Norway evaluated contact allergy in patients with chronic leg ulcers due to venous stasis that were present for 6 weeks or more. Patch testing was performed with the Leg Ulcer Series and the European Baseline Series (EBS). The patients removed the patches themselves after 48 hours and presented to clinic for one reading conducted at day 3. The most frequent allergens in the leg ulcer series were to wood tar mix, benzalkonium chloride, and fusidic acid, as well as INTRASITE Gel and topical steroids. The most common allergens in the EBS were Myroxylon pereirae, fragrance mix, colophonium, and thiuram mix. In this study, 40% of patients with a positive patch test had one reaction, 33% had two reactions, 10% had three reactions, and 17% had four or more reactions, reminding us that multiple allergens can be common in this scenario due to the reality that numerous potential allergens are applied to the wound. 

The study is limited by the solitary reading at day 3 and is also limited in part by the geographic differences in products and wound dressing practices that may not translate to similar allergens being generalizable to other regions or countries. However, the study does highlight the need for clinicians to consider contact allergy in the setting of chronic leg ulcerations.

Dermatologists should consider contact allergy in the setting of any chronic wounds when routine wound care does not result in typical healing, there is significant surrounding dermatitis, significant pruritus, or if a wound was progressing and then halts or worsens. The potential allergens include all topical preparations, both-over-the counter and prescription, as well as the dressings particular to the patient and the clinic where he/she is being treated.

Abstract 

Contact allergy (CA) is prevalent in patients with chronic leg ulcers (CLUs) due to venous stasis1and may delay wound healing. Exposure to different ointments and wound dressings over time, combined with occlusive bandaging, may predispose to contact sensitization.2The spectrum of allergens depends on wound care practices.3, 4 Studies on CA in patients with CLUs from Norway are lacking. To determine the occurrence of CA in patients with CLUs, patch testing was performed with the Leg Ulcer Series (LUS) containing 27 chemicals and five additional substances relevant to wound treatment: Caine mix III and V, hydrocortisone, IntraSite gel (propylene glycol 20%, Smith & Nephew), and Brulidine (dibrompropamidine 0.15%, Sanofi‐Aventis) (Table S1). Fifty‐two of the 97 patients were also tested with the European Baseline Series (EBS) (Table S2).

Contact Dermatitis

Contact Allergy in Patients With Chronic Venous Leg Ulcers

Contact Derm 2020 Dec 27;[EPub Ahead of Print], AH Lossius, M Lorentzen, J Austad, TK Bergersen 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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